Provider Demographics
NPI:1609356856
Name:GRUMLEY, ELIZABETH (COTA/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GRUMLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 41ST ST # 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3431
Mailing Address - Country:US
Mailing Address - Phone:818-640-4037
Mailing Address - Fax:
Practice Address - Street 1:3085 41ST ST # 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3431
Practice Address - Country:US
Practice Address - Phone:818-640-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008860-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant